An Exploration of Adolescent Obesity Determinants

In 2010, approximately two-thirds of adults and one-fifth of the adolescent population in the United States were considered either overweight or obese, resulting in the United States having the highest per capita obesity rate among all OECD countries. A considerable body of literature regarding health behavior, health outcomes, and public policy exists on what the Centers for Disease Control and Prevention considers an obesity epidemic. In response to the growing problem of childhood obesity, the Child Nutrition and WIC Reauthorization Act of 2004 (CNRA), which required that schools participating in the National School Lunch Program and/or School Breakfast Program have wellness policies on file, was passed. The purpose of this research is to provide additional insight into the origin of the geographic variation in adolescent obesity rates between the U.S. states. Previous research has looked at differences in built environments, maternal employment, food prices, agriculture policies, and technology factors in an effort to explain the variation in adolescent obesity prevalence. This dissertation contributes to the literature by examining the hypothesis that state-level school wellness policies also played a role in determining the rates of childhood obesity. Using School Health Policies and Practices Study (SHPPS) surveys from 2000 – 2012, I derived a state-level school wellness policy measure. This, together with Youth Risk Behavior Surveillance survey data on adolescent BMI was used to measure the effect of the wellness policy mandate on adolescent obesity prevalence. Several models were applied to first demonstrate that the state of residence for an adolescent is indeed related to BMI trends and then to investigate various determinants of adolescent obesity including the primary variable of interest, state school wellness policies. The results of this research provide evidence of a statistically significant, although very small positive effect of school wellness policies on adolescent BMI that is contrary to my hypothesis. Dominance analysis showed that of the four wellness policy factors considered in the principal component composition of the wellness policy measure, policy components that met state requirements rather than those meeting health screen criteria, state recommendations, and national standards were most important in explaining the overall variance of the regression model. Interestingly, the public school attendance rate itself was also associated with a substantial decrease in adolescent BMI. Understanding the determinants of adolescent obesity and how to effect change in the rising trend is a national concern. Obese adolescents are at significant risk of becoming obese adults and previous research has already shown the high economic costs associated with adult obesity and its comorbidities. Policies implemented in school, where adolescents consume a considerable portion of their daily calories and participate in physical activity, can help to build healthy habits that have the potential to lower the probability of an adolescent becoming an obese adult. Over time, a healthier adult population may result in lower economic costs associated with medical care and lost productivity